Copy of dentinogenic ghost cell tumor ready / dental implant courses

INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

CASE HISTORYCASE HISTORY
Chief Complaint:
 Swelling – One month
 Pain – 15 days
History of Present Illness:
 Swelling – insidious in onset, small size
 Associated with pain, insidious in onset, continuous,
dull aching, localised, aggravates on chewing food.

Past Medical History:
Past Dental History:
 Got teeth extracted 4yrs back due to decay and pain
and is a complete denture wearer since four months.
Personal history:
 Habits: Patient smokes 25 beedies per day since 40yrs.

Indian Dental academy
• www.indiandentalacademy.com
• Leader continuing dental education
• Offer both online and offline dental courses

 General Physical Examination:
 Extra Oral Examination:
 Lymph node Examination:
Left Submandibular lymphadenopathy.

 Intra Oral Examination:

DIFFERENTIALDIFFERENTIAL
DIAGNOSISDIAGNOSIS
 Fibroma
 Peripheral Ameloblastoma
 Neurofibroma
 Peripheral Odontogenic Fibroma
 Peripheral Giant Cell Granuloma

INVESTIGATIONSINVESTIGATIONS
Routine Blood and Biochemical investigations
done.
Radiographs
Biopsy of the lesion.

Intra Oral Periapical
Radiograph

PANORAMICPANORAMIC
RADIOGRAPHRADIOGRAPH

Histopathology
Hematoxylin and Eosin Specimen, 10X
Ameloblast
like cells

Hematoxylin and Eosin Specimen, 20x
Histopathology
Ghost
cell
Dentinoid
Material

VANGIESON STAIN, 10X
HISTOPATHOLOGY
Ghost
cell
Dentinoid
Material

FINAL DIAGNOSIS
Dentinogenic Ghost Cell
Tumor

TREATMENT
Surgical Excision of the lesion done.

Three Months Later

DISCUSSION

Dentinogenic Ghost Cell Tumor
First proposed by Praetorius in 1981
Synonyms:
Odontogenic Ghost Cell Tumor(Colmero et al,1986)
Calcifying Ghost Cell Odontogenic Tumor
(Fejerskov & Krogh, 1992)
Epithelial Odontogenic Ghost Cell Tumor (Gunhan
et al, 2001)
Dentinoameloblastoma (Shear)www.indiandentalacademy.com

TumorDentinogenic ghost cell tumor is defined as solid
neoplastic growth formed by groups and islands of
epithelial cells showing an ameloblastoma-like basal
cell layer that sometime shows nuclear polarization.
Quintessance International, 1997;28(1): 45-47

Tumor
Hong et al classified into Two Types,
1.Central or Intraosseous type
2.Peripheral or Extraosseous type
American Journal of Neuroradiology, 2001;22:175-179

Tumor
Peripheral Type:
 Remain localized.
 Age –50-72yrs, mean age – 53.8yrs
 Sex – Males
 Occur on the gingiva and edentulous alveolar
ridge on alveolar mucosa.
 Peripheral presentation is related to their
infiltrative behaviour and appears to be
common.

Peripheral DGCT
 Size varies from 1.5cm to 2cm.
 Present as sessile or pedunculated exophytic nodules
of gingiva.
 May be tender or non tender, hard or soft and friable.
Journal of Clinical Periodontology,2007;78(8):1635-38

Radiologic Features
Peripheral Type:
Causes no alteration or only mild erosion or
saucerization of cortical bone.

Histopathologic Features
 Ameloblastoma like epithelial elements are seen
in association with grouped ghost cells.
 Ghost cells exhibit abundant, granular
eosinophilic cytoplasm and faint nuclear outline.
 Ghost cells form stratified masses with several
portions entrapped within areas of irregular
osteoid or dentinoid material.

Tumor
There is proliferative epithelium and ghost cells
interspersed with abundant dentinoid like
material, hence the lesion is called dentinogenic
ghost cell tumor.

Immunohistochemistry
 Bcl – 2 and MIB-1 - positivity for cells of
odontogenic epithelium
 The ghost cells and dentinoid material are
completely negative .
Journal of Periodontology, 2007; 78(8):1635-38

TREATMENT
Peripheral lesion remain localised and can be
treated with simple excision.
• Do not recur.
BJOMS, 2004; 42(2):173-75

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